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7th Semester > 400 Exam 5 - Part 2 > Flashcards

400 Exam 5 - Part 2 Flashcards

1
Q

roles of the liver

A 
carb/glucose metabolism
protein metabolism
fat metabolism
production of bile salts
bilirubin metabolism
detoxification
activates estrogen, testosterone, ADH, aldosterone
storage of minerals and vitamins
blood reservoir
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2
Q

what does the liver detoxify?

A

ammonia (NH3)

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3
Q

the liver is Very important in metabolizing certain medications:

A

barbituates
amphetamines
sedatives

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4
Q

ϖ Storage of minerals & vitamins

A 
A
D
B12
Iron
Copper
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5
Q

Patients with liver failure often require vitamin therapy. Which vitamin does the liver require for synthesis of prothrombin?

A

A. Vitamin K

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6
Q

o Healthy person rapidly develops severe liver dysfunction marked with the onset of cerebral edema or encephalopathy (swelling of the brain) and/or bleeding due to the inability to clot

A

ϖ Acute—Fulminant Hepatic Failure

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7
Q

o Can also have multiple organ failure

o ¾ of these die within days of onset

A

Acute Liver Failure

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8
Q

Treatment of acute liver failure

A

liver transplant

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9
Q

With acute liver failure they develop massive necrosis of _____.

A

hepatocytes

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10
Q

high _____ levels with acute liver failure

A

ammonia

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11
Q

risk for ____and ____ with acute liver failure

A

sepsis and shock

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12
Q

causes of acute liver failure

A

Heb B infection
tylenol OD
mushroom poisoning
Eclampsia/preeclampsia during pregnancy

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13
Q

o What you mostly deal with

o Is progressive, irreversible destruction of the liver function over time

A

Chronic Liver Failure

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14
Q

ex of Chronic Liver Failure

A

chrrhosis and Hepatitis C

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15
Q

o Hepatitis can cause acute liver failure, but most associated with _____.

A

chronic

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16
Q

liver failure is diagnosed by ?

A

several abnormal blood and urine test

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17
Q

liver failure is confirmed by?

A

liver biopsy

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18
Q

o Removal of a small amount of liver tissue, usually through needle aspiration—permits examination of liver cells

aids in establishing cause of liver disease

A

liver biopsy

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19
Q

o Most common indication is to evaluate diffuse disorders of the parenchyma and to diagnose space occupying lesions

A

.

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20
Q

_____ and ____ _____ after liver biopsy are the major complications; therefore, coagulation studies are obtained, their values are noted, and abnormal results are treated before liver biopsy is performed

A

o Bleeding and bile peritonitis

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21
Q

o Can be performed percutaneously with ultrasound guidance or transvenously through the right internal jugular vein to right hepatic vein under fluoroscopic control – Can also be performed laparoscopically

A

liver biopsy

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22
Q

pre op liver biopsy

A

consent
NPO for several hours
Bleeding times and coagulation studies

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23
Q

don’t perform needle biopsy if?

A

pt has any bleeding disorders;

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24
Q

can be admin for several days before and after if they have bleeding problems

A

Vit K (aqua mephyton)

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25
Q

• Patient lies supine and the skin is prepped over the ____ and ___ intercostal space and lidocaine is injected

A

8th and 9th

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26
Q

what to do when they insert the needle

A

hold breath

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27
Q

what to monitor for after liver biopsy?

A

signs and symptoms of shock and bleeding

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28
Q

VS how often ?

A

every 10-15 min for 1st hour

every 30 min for 1-2 hrs

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29
Q

how should patient lye for several hours after?

A

− Have the patient lie on the right side with a small blanket folded under the costal margin for several hours.

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30
Q

− Bed rest for ____ hours or longer

A

8-10

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31
Q

other diagnostic tests for liver failure

A

Ultrasoundography, CT, MRI
Radioisotope liver scan
Laparoscopy

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32
Q

identify normal structures and abnormalities

A

o Ultrasoundography, CT, MRI

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33
Q

assess liver size and hepatic blood flow and obstruction

A

o Radioisotope liver scan

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34
Q

insertion of a fiberoptic endoscope through a small abdominal incision

  • Used to examine liver and other pelvic structures
  • Used to perform guided liver biopsy, determine cause of ascites, and diagnose and stage tumors of liver and other abdominal organs
A

o Laparoscopy

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35
Q

enlarged

tender

A

recent enlargement

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36
Q

enlarged

non-tender

A

long term enlargement

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37
Q

small hard

A

cirrhosis

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38
Q

soft, easily moveable edges

A

acute hepatitis

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39
Q

tender

A

viral hepatitis

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40
Q

non-tender

A

alcohol hepatitis

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41
Q

o More than ___% of the parenchyma of the liver may be damaged before liver function test results become abnormal

A

70%

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42
Q

o Generally measured in terms of serum enzyme activity and serum concentrations of proteins, bilirubin, ammonia, clotting factors, and lipids

o Nature and extent of hepatic dysfunction cannot be determined by these tests alone

A

liver function tests

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43
Q
  • Sensitive indicators of injury to the liver cells

* Useful in detecting acute liver disease such as hepatitis

A

o Serum aminotransferases (AST, ALT)

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44
Q

• AST and ALT are found primarily in the liver and elevate with ____ and ____

A

liver inflammation and trauma

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45
Q
  • One of the most frequently used tests of liver damage
  • Present in tissues that have high metabolic activity; therefore, the level may be increased if there is damage to or death of tissues of organs such as heart, liver, skeletal muscle, and kidney
A

AST (Aspirtine)

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46
Q

AST (Aspirtine) levels

A

10-40 units/ml

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47
Q

• Not specific to liver disease—level of AST may be increased in what 3 conditions ?

A

cirrhosis, hepatitis, liver cancer

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48
Q
  • One of the most frequently used tests of liver damage
  • Increase primarily in liver disorders
  • Primarily in the liver cells and may be used to monitor the course of hepatitis or cirrhosis or the effects of treatments that may be toxic to the liver
A

ALT

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49
Q

ALT levels

A

8-40

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50
Q
  • One of the most frequently used tests of liver damage
  • Increased levels are associated with cholestasis but can also be due to alcoholic liver disease
  • Kidney has highest level of the enzyme liver is considered the source of normal serum activity
  • Determine liver cell dysfunction; Sensitive indicator of cholestasis
  • Main value in liver disease is confirming hepatic origin of elevated alkaline phosphatase level
A

GGT

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51
Q

GGT level

A

0-30 U/L

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52
Q

• Our protein to see if person is adequately nourished and see if at risk for F&E imbalance—important

A

Albumin

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53
Q

Albumin levels

A

3.5-5.5 g/dL

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54
Q

Worry about bleeding

may be prolonged in liver disease

• It will not return to normal with vitamin K in severe liver cell damage

A

Prothrombin time

55
Q

Prothrombin time level

A

100% or 12-16 seconds

56
Q

• Any time we have liver problems, we worry about the capabilities of the body to properly excrete toxic ____

A

ammonia

57
Q

ammonia levels

A

15-45 mcg/dL

58
Q

o Accumulation of fluid in the peritoneal cavity

o Caused by an increase in the portal pressure in the portal circulation that causes an increased hydrostatic pressure

o Liver is not able to produce albumin or protein so there’s a decrease in oncotic pressure to keep the fluid in the vascular space
o Fluid pulled into peritoneal cavity third spacing

A

ascites

59
Q

sx of ascites

A 
hard, firm belly
resp distress (SOB)
increased abd girth and rapid weight gain
striae
hernias
F/E imbalances
hypovolemia
hypokalemic
60
Q

removal of fluid from peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions

A

o

PARACENTESIS

61
Q

•Assess very well before they have this done because you need a baseline you’re pulling a lot of fluid out at one time! (not uncommon to see ___-___ Liters

A

5-6 Liters)

62
Q

prior to paracentesis

A 
consents and witness signature
empty bladder immediately before
assist to upright position
monitor pain and vitals
monitor for hypovolemic shock
63
Q

hypovolemic shock sxs:

A

tachycardia hypotension

64
Q

after procedure

A

monitor site for leakage
rigidity and pain of abd (peritonitis)
monitor albumin and potassium levels

65
Q

− Often after paracentesis ______ is given by IV to replace from what was drawn out of the body

A

albumin

66
Q

ϖ Diffuse inflammatory disease of the liver; Ranges greatly in severity

A

hepatits

67
Q

ϖ Hepatitis Can be caused by several different types of toxins, viruses, disease states

A

autoimmune
viral
fulminant (Acute Liver Failure)
Hepatitis A-E

68
Q

ϖ Any of these can cause ______________, which is necrotic tissue leading to scarring of liver and could cause chronic liver failure

A

post-necrotic cirrhosis

69
Q

o However, very uncommon for Hepatitis ____ and ____to progress to chronic liver failure

A

A and E

70
Q

ϖ Clinical manifestations of Acute viral hepatitis occur in three phases: (not mentioned in book)

A

preicteric
icteric
posticteric

71
Q

♣ Prodromal time that it can begin, abruptly or gradually
♣ Often symptoms are vague & may be mistaken for the flu joint pain, some fatigue, loss of appetite, nausea, cough
♣ Gradually the liver enzymes, AST, ALT, and bilirubin, start to increase and start to get an increase in viral antibodies

A

preicteric

72
Q

jaundice phase

usually a week or so after preicteric phase

A

icteric

73
Q

recovery phase
lasts several months
labs return to normal gradually
fatigue continues on!!!

A

posticteric

74
Q

• Not discussing in detail, it’s now being called post transfusion hepatitis; Not a lot of info out there, kind of a mystery

A

Hepatitis G

75
Q

(often referred to as acute liver failure) is a rapid progression of liver failure which any of these can result in.

A

o Fulminant

76
Q

Fulminant usually doesn’t occur with which two hepatitis?

A

A and E

77
Q

ϖ Causes diffuse inflammation to the liver with either spotty or single-cell necrosis and liver becomes swollen

ϖ Inflammation and degeneration of the tissue, then we have regeneration so it can heal

A

Hep A and E

78
Q

Hep A and E are transmitted how

A

fecal-oral route

79
Q

ϖ Don’t confuse acute hepatitis and acute liver failure .

Acute hepatitis means

A

they have active symptoms now, doesn’t mean their liver is failing

80
Q

ϖ Transmitted primarily through the Fecal oral route, by ingestion of foods and liquids infected by a virus (RNA virus of Enterovirus family)

A

Hep A

81
Q

how is Hep A commonly spread

A

overcrowding
poor sanitation
adult population

spread through water, food, shellfish

82
Q

healthcare workers are not at high risk for Hepatitis ___.

A

A

83
Q

o People at risk for Hep A

A

travelers,
daycare workers dealing w/ diapers & stool,
food handlers can contaminate food,
crowded living areas

84
Q

o Most recover from hepA

rarely progresses to ____ or _____ _____ resulting in liver cirrhosis or death

A

acute liver necrosis or fulminant hepatitis

85
Q

sx of Hep A

A 
Anicteric
mild, flu like sxs
low grade fever
severe anorexia
jaundice
dark urine
dyspepsia
indigestion
strong aversion to the taste of cigarettes
86
Q

o Symptoms last about ___ months and fatigue can last for quite some time after illness is resolved

(Hep A)

A

2 months

87
Q

o Jaundice Usually by the time jaundice gets bad with Hep A, all the other symptoms go away—usually around day ___ after symptom onset

A

10

88
Q

effective and safe vaccine for Hep A

A

Havrix

Vagta

89
Q

how is the vaccine given?

A

18 or older

2nd dose given 6-12 months after the first

90
Q

children or adolescents receive 3 HAV vaccines how:

A

second dose is given 1 month after first

third dose is given 6-12 months later

91
Q

who is HAV vaccine recommended for?

A

people traveling to location where sanitation and hygiene are unsatisfactory, for those from high risk group, such as homosexual men, IV or injection drug users, staff of day care centers, and health care personnel

92
Q

♣ Hepatitis A can be prevented by IM admin of globulin during the incubation period, if given w/in ___ weeks of exposure

A

2 weeks

93
Q

o Liver & spleen are often moderately enlarged for few days after onset; other than jaundice, there are few other physical signs

A

Hep A

94
Q

o HepA may be in stool for ___-____ days before illness and for __-___ weeks after symptoms appear—stool contagious for quite awhile

A

7-10

2-3

95
Q

prevention of Hep A

A

hand washing
proper disposal of sewage
safe water supply
preventable vaccine when traveling

96
Q

ϖ Transmitted by the fecal oral route, principally through contaminated water in areas with poor sanitation

A

Hep E

97
Q

ϖ Usually due to infected water supply Don’t normally see in the U.S. but in ?????epidemics have been reported

A

Asia, New Mexico, and Africa

98
Q

Hep E is more prevalent in

A

pregnant women

99
Q

Hep E in pregnancy can develop too?

A

fulminant hepatitis

100
Q

no vaccine or prophylactic treatment with ____

A

Hep E

101
Q

incubation period for Hep E

A

15-65 days

102
Q

ϖ HDV requires the presence of ____ to be active

A

HBV

103
Q

HBV is transmitted

A

blood

104
Q

HBV can cause

A

acute hepatitis
chronic hepatitis
fulminant

105
Q

high risk for HBV

A

IV drug users
babies whose mothers are infected
people who have lots of blood transfusions
people with multiple sex partners

106
Q

how is HBV transmitted to baby:

A

at time of birth and during close contact after

107
Q

ϖ More than 90% of people who contract HBV develop antibodies and can recover spontaneously w/in ____ months if immune system is proper

A

6

108
Q

sx of HBV

A 
arthralgia and rashes
loss of appetite
dyspepsia
abdominal pain
generalized aching
malaise
weakness
may or may not have jaundice
109
Q

o Incubation period much longer can have it and not know it for ___-___ months
with HBV

A

1-6 months

110
Q

prevention of HBV

A

screening of blood donors
disposable syringes, needles, lancet
good hygiene
wear gloves when handling bodily fluids

111
Q

♣ Active immunization is recommended for people who are high risk for ____-

A

hepatitis B

112
Q

who else should get HBV vaccine

A

people with Hep C and other chronic liver disease

113
Q

how is HBV vaccine given

A

IM in 3 doses:

the second and third doses are given 1 and 6 months after the first dose

114
Q

o If a person has been exposed but never had disease or immunization – they can receive

A

HBIG (HB immunoglobulin)

115
Q

o Indicated for people exposed to HBV who never had hepatitis B and have never received hepatitis B vaccine

A

o Passive immunity

116
Q

o If known exposure they may get this HBIG, should be done promptly within

A

a few hours or couple days

117
Q

goal for HBV

A

minimize infectivity and liver inflammation and decrease symptoms

118
Q

if you have Hep D you also have ?

A

Hep B

119
Q

Hep D is common with:

A

IV drug users
hemodialysis patients
recipients of multiple drug transfusions

120
Q

ϖ Symptoms same as Hepatitis B however they ???????? compared to HBV

A

increase in severity

121
Q

ϖ Accounts for nearly half of all new hepatitis cases

ϖ Screening has significantly reduced number of blood transfusion transmissions

A

hep C

122
Q

IV drug use is still most common cause of getting ?

A

Hep C

123
Q

is there a vaccine for C?

A

NO

124
Q

most common S/E of Hep C

A

hemolytic anemia

125
Q

nursing care for patient with acute viral hepatitis:

A 
adequate hydration
adequate nutrition
managing symtoms
rest
HIGH calorie diet
small freq. meals
avoid ALCOHOL
manage HA without pain meds
control itching
126
Q

o Can have increased PT because clotting factors are impaired because this is a function of the liver —> may be giving ____ __.

A

Vitamin K

127
Q

o Restrict _____ and ____ if liver function is impaired

A

protein and sodium

128
Q

pre exposure vaccine for travelers and people at risk; post exposure vaccine if exposed

A

o Hepatitis A

129
Q

preexposure vaccine recommended for all high risk; post exposure

HBIG w/in hrs-days of exposure + vaccines

A

o Hepatitis B

130
Q

no vaccine

A

o Hepatitis C and E

131
Q

requires B to be active

A

o Hepatitis D

132
Q

is an involuntary tremor or flapping of the hands (also called liver flap) indicator of high ammonia levels and are developing PSE/hepatic coma/encephalopathy; can also be seen in the tongue and in the feet

A

Asterixis

133
Q

o Patients with all forms of hepatitis should avoid

A

drinking alcohol and eating raw shellfish

7th Semester (14 decks)

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